Prognostic value of heart valve calcifications for cardiovascular events in a lung cancer screening population
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Published on: August 28, 2018
Martin J Willemink1, Richard A P Takx, Ivana Išgum
1Department of Radiology, University Medical Center Utrecht, E01.132, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands, m.willemink@umcutrecht.nl.
Insights
Aortic valve calcifications predict cardiovascular events in heavy smokers. However, adding heart valve calcium to existing risk factors did not improve short-term cardiovascular event prediction.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Cardiovascular disease (CVD) risk stratification is crucial, especially in high-risk populations like heavy smokers.
- Lung cancer screening CT scans offer opportunities to assess non-pulmonary findings, including cardiovascular calcifications.
- The prognostic value of heart valve calcifications for CVD events remains incompletely understood.
Purpose of the Study:
- To evaluate the predictive capability of aortic and mitral valve/annulus calcifications for cardiovascular events.
- To determine if heart valve calcifications add prognostic value beyond established risk factors and coronary/aorta calcifications.
Main Methods:
- Retrospective analysis of 3111 heavily smoking men without prior CVD undergoing low-dose chest CT for lung cancer screening.
- Assessment of non-imaging (age, smoking status, pack-years) and imaging predictors (coronary, aorta, aortic valve, mitral valve/annulus calcium volume).
- Multivariable Cox regression and concordance statistics (c-statistics) to analyze cardiovascular event occurrence.
Main Results:
- A total of 186 (6.0%) participants experienced a cardiovascular event during follow-up (2.9 years).
- Aortic and mitral valve/annulus calcifications were associated with increased cardiovascular event incidence (9.0% and 12.9%, respectively).
- Aortic valve calcifications showed prognostic value (HR 1.46 per 500 mm³), but adding heart valve calcium volume to a model with age, smoking, and coronary/aorta calcium did not improve the c-statistic (0.68).
Conclusions:
- Aortic valve calcifications are independent predictors of future cardiovascular events in this cohort.
- Heart valve calcifications do not provide additional prognostic information for short-term cardiovascular events when considering established risk factors and coronary/aorta calcifications.
- Low-dose chest CT during lung cancer screening can identify individuals with aortic valve calcifications who may benefit from closer cardiovascular monitoring.
Abstract:
To assess the prognostic value of aortic valve and mitral valve/annulus calcifications for cardiovascular events in heavily smoking men without a history of cardiovascular disease. Heavily smoking men without a cardiovascular disease history who underwent non-contrast-enhanced low-radiation-dose chest CT for lung cancer screening were included. Non-imaging predictors (age, smoking status and pack-years) were collected and imaging-predictors (calcium volume of the coronary arteries, aorta, aortic valve and mitral valve/annulus) were obtained. The outcome was the occurrence of cardiovascular events. Multivariable Cox proportional-hazards regression was used to calculate hazard-ratios (HRs) with 95% confidence interval (CI). Subsequently, concordance-statistics were calculated. In total 3111 individuals were included, of whom 186 (6.0%) developed a cardiovascular event during a follow-up of 2.9 (Q1-Q3, 2.7-3.3) years. If aortic (n = 657) or mitral (n = 85) annulus/valve calcifications were present, cardiovascular event incidence increased to 9.0% (n = 59) or 12.9% (n = 11), respectively. HRs of aortic and mitral valve/annulus calcium volume for cardiovascular events were 1.46 (95% CI, 1.09-1.84) and 2.74 (95% CI, 0.92-4.56) per 500 mm(3). The c-statistic of a basic model including age, pack-years, current smoking status, coronary and aorta calcium volume was 0.68 (95% CI, 0.63-0.72), which did not change after adding heart valve calcium volume. Aortic valve calcifications are predictors of future cardiovascular events. However, there was no added prognostic value beyond age, number of pack-years, current smoking status, coronary and aorta calcium volume for short term cardiovascular events.
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